Above: Before and after Botox injection of crow’s feet area-patient is smiling hard in both photos.

Botox or Botulinum Toxin A can do much more for your health and well being than removing wrinkles from your face. Contrary to popular myth, Botox or Botulinum Toxin A is not like getting food poisoning. Botox or Botulinum Toxin A is a very effective helpful medication for many serious human illnesses.

Botox has been used safely for over 30 years and has helped many thousands of people. Botox or Botulinum A injections do not leave you without facial expression looking like a figure in a wax museum if injections are done by an expert and not at a Botox party. Botox injections can cure headaches, fix a lazy or crooked eye, relieve muscle spasm, help stroke patients, relieve bladder incontinence, stop tics and facial twitches, help back pain, and reduce excessive sweating as well as many cosmetic wrinkle reducing applications.

Botox or Botulinum A has an incredible safety record when administered by an experienced licensed physician, however Botox parties and other unlicensed uses have resulted in complications and unhappy results.

There is, however, much confusion and misinformation about Botox and Botulinum Toxin A in the popular media which has frightened many people who potentially could be helped by this remarkable medicine.

Most negative news about Botox is the result of misuse of this medication by inexperienced or non-licensed users of Botulinum Toxin A often taking place in non-licensed or non-medical facilities.

The most widely used indications for Botox are certainly cosmetic. Wrinkle removal, brow lifting, removal of crow’s feet, frown lines, worry lines, lip lines and the liquid face lift are the most common day to day uses of Botox or Botulinum Toxin A.

Before and after Botox and Restylane to reduce Lip Lines

Above: Before and after botox injection to remove lip lines and lift the lower face and mouth with liquid face lift.

However, many more serious medical uses are available that can help people lead more comfortable lives after suffering very serious medical illnesses.

In this article I will give an objective description of Botox, how it is used, what it can achieve, and how it can be safely administered. Hopefully, the reader will be more accurately informed about this very helpful medication and learn how Botox may be used to help you, a friend or family member improve very common medical problems.

What Is Botox?

Botox or Botulinum Toxin A is a highly diluted synthetic medical grade medication which weakens muscles when injected directly into the muscle fiber.

Botulinum toxin in nature is produced by bacteria called Clostridium Botulinum whose spores are widely distributed in the soil, ocean sediments, and can be found on many fruits and vegetables. The spores are harmless. However, under the right conditions, that lack oxygen, spores can produce the bacteria, Clostridium Botulinum which can produce the natural toxin. Natural Botulinum toxin which can cause muscle paralysis. The most common cause is food poisoning from ingesting improperly preserved food.

The muscle relaxing effect of Botulinum Toxin has been harnessed to provide many beneficial medical treatments by synthesizing a diluted safe form of Botulinum A toxin called Botox that can safely be used under medical supervision.

How Does Botox Work?

Botulinum Toxin A works directly on the muscle fiber to weaken the contraction of the muscle. All of our muscles are attached to nerves. When we flex, tighten or contract a muscle, the nerve sends electrical impulses to the muscle to make the muscle tighten. The nerves connect to the muscle at a specific point called the neuromuscular junction (nerve to muscle connection). Actually, the end of the nerve is not in direct contact with the muscle.

There is a small space between the nerve ending and the muscle. When the nerve impulse or electrical message gets to the end of the nerve, a chemical called Acetylcholene is released from the nerve, travels across the small gap to the muscle, and stimulates or causes the muscle to contract.

Botox works by blocking the action of Acetylcholine on the muscle, thus the muscle relaxes when the Acetylcholine is blocked.

This muscle relaxing effect is very useful medically in any condition in which increased or excessive muscle tone or spasm is causing pain or disability.

In addition, all of our muscles have a normal resting muscle tone or tension even when we are not actively contracting the muscle. In our facial muscles that cause expression lines such as crow’s feet, worry lines and frown lines, this resting tone causes these lines. Injections can relax the resting muscle tone that is pulling on the skin and causing lines.

This is a direct effect and is produced by the direct injection of the Botulinum Toxin A into the muscle.

How to Use Botox–What Can Botulinum Toxin A Do for You?

• Headache-Botox injections into painful trigger points where headaches and migraine headaches start can produce dramatic relief for people who suffer headache.

• Excessive sweating-Because Acetylcholine also causes sweat glands to produce sweat and Botox injections can significantly reduce sweating in the palms, feet and underarm areas. This can eliminate wet lines caused by sweating on dresses during high stress times such as weddings.

• Bladder control-Many people suffer from urinary incontinence from spastic bladders. Urologists can use injections of Botox to relieve bladder spasm and reduce incontinence.

• Relieve spasms, twitches, back pain-Muscle spasms are painful and disabling in many conditions such as Torticollis (neck spasms), back spasms, cerebral palsy, after stroke and other spastic conditions. Relaxing muscle spasms with Botox can help both function and pain control

• Facial and Eye Spasms and Tics-Many people suffer from facial and eyelid twitches called tics that can be relieved by Botulinum Toxin A injections.

• Help Stroke victims-Many people are disabled by spasm and over activity of muscles affected by stroke. Properly placed Botox injections can be very helpful in relaxing spastic muscles that interfere with normal activities.

Above: Before and after Botox injection to reduce squinting, crow’s feet and eye wrinkles.

• Cosmetic applications-Cosmetic applications are the most commonly used forms of Botox therapy. Frown lines, worry lines, lip lines, crow’s feet can all be lessened. Newer liquid face lift techniques can lift the corner of the mouth and improve jowls. A botox brow lift is also possible.

Before and after Botox for Brow Lift and reduce Frown Line

Above: Before and after Botox injections, eye lift and brow lift to open the eyes and reduce frown lines.

Botulinum Toxin A relaxes the muscles that cause specific wrinkles or lines in the face. These lines or wrinkles occur because of tension or contraction of the muscles of facial expression. These muscles only function is expression. They are not involved in necessary function such as chewing smiling, eye blinking and other important functions.

The lines or wrinkles that can be helped or reduced are the frown lines, worry lines, crow’s feet, lip lines and lines that pull the lower lip down and accentuate the jowls.

Some wrinkles are permanent indentations in the skin caused by years of muscle pull and aging of the skin caused by sun damage. These wrinkles will not be helped. Other wrinkles on the face caused by aging and sun damage that are not caused by muscle pull cannot be helped with Botulinum Toxin A.

Does Botox Lift the Face-Is Botox Non-surgical Face Lift True?

No. Botulinum Toxin A relaxes muscles and does not tighten or lift any part of the face. However, some muscles around the mouth pull the lower face down and create jowls and marionette lines. If these muscles are relaxed with Botox, the lower face is lifted by the upper face muscles, thus a Botox lower face and mouth lift is possible.
Botox is used along with Facial Fillers like Restylane, Perlane, Juvederm, Sculptra, and Radiesse to relax muscles that are pulling the corners of the mouth down which allows the corner of the mouth to be lifted by unopposed muscle action and the plumping effect of the filler. These techniques are referred to as a liquid face lift.

How is Botox Given?

Injections are done through a very tiny 32 gauge needle and are relatively painless. I use a topical anesthetic and cool the muscle and skin with ice or a special chilled Titanium roller. When using these techniques, many patients say they do not even feel the injection.

How Close to A Special Event Should I Get Treatment?

I recommend at least a week or two before a special event. The Botulinum Toxin A works fast, in a day or so but full effect can take two weeks. The main reason to start early is in case you bruise. You will need 10 days to two weeks for the bruise to completely resolve.

Will I Bruise After My Botox Injection?

Bruising after injection happens 10-20 per cent of the time and nearly 100% of bruises occur during injection of the crow’s feet area. This is because there are so many tiny blood vessels around the eyes and the skin is very thin and fragile. I try very carefully to see and avoid these tiny vessels but sometimes they are invisible and a small bruise occurs. We apply pressure and cold packs immediately after injection which also helps avoid bruising.

How To Avoid Bruising After Injection?

Be sure to avoid aspirin or any blood thinning agent before Botulinum Toxin A injection. Careful technique to avoid any small blood vessels helps a great deal. Cold packs prior to injection shrink the vessels and lessen the risk of a bruise. Pressure and cold packs immediately after injection also helps avoid bruising.

I also recommend taking the herb Arnica Montana either before or immediately after injection which also can help with bruising.
When Will I See Results of My Injection?

You will see results in 24 hours after injection. Full effects can take up to two weeks to be seen.

What If I Do Not Respond To My Injection?

Very small per cent ages of patients just do not respond to Botulinum Toxin A. In my experience only about 1 or 2 % of patients fail to have a response. In all cases, the non-responders have been dark skinned people of Mediterranean or Southern European extraction and have had larger than usual muscles. In contrast, Northern European people, very thin skinned fair complected people usually have excellent results that can often last longer than usual.

Another possibility if you do not respond is that diluted, out of date solution was used or the injection technique was not proper. Be concerned if the price is lower than average-you usually are getting diluted Botulinum Toxin A which will not be effective. Also, only have injections by board certified plastic surgeons and dermatologists who do a lot of these treatments. Experience and technique are very important to achieve the best result.

What Should I Avoid Before Having An Injection?

Avoid aspirin and other blood thinning medications prior to injection.

Also avoid heavy exercise and exertion before and the first day as increased heart rate and blood pressure will increase the risk of bruising.

How Long Does Botox Last?

On average, to maintain the best possible correction, plan on repeating your treatments every 3-4 months.

While the effect may last 6-12 months in some people, especially fair thin skinned people, as the effect wears off wrinkles will return.

Yes, when pharmaceutical grade Botulinum Toxin A manufactured by Allergan is injected in the proper dosage, with proper technique by an appropriately trained and experienced physician.

What Are Potential Complications?

The most common complication is inadvertent injection into the wrong muscle. If this happens, the eyelid can droop temporarily for about 2-3 weeks, but this is reversible once the injection wears off.

Occasionally when used to correct lip lines pursing action of the muscle when whistling or drinking through a straw can be compromised. This also will return to normal in 2-3 weeks.

Other uncommon temporary side effects can include headache, flu like syndrome, and nausea, but they are very unusual in my experience. A definite causal relationship of these symptoms with Botulinum Toxin A has not been established.

How Will I know If I Have A Bad Reaction?

You will notice any weakness in the eyelid or mouth within 3-4 days. Be patient, notify your doctor and you will recover.

If you develop a headache or flu like syndrome in the first few days afterinjection, notify your doctor, and discuss whether you are a candidate for further injections in the future.
Who Should Give These Injections?

This is a controversial topic. Many physicians have delegated injections to a nurse or PA which is legal in some states.

My own policy is that I do the injections myself. I have knowledge of the muscle anatomy from direct observation in surgery and the aesthetic experience and judgment to evaluate what technique and location of injection will give you the best result.

I personally believe that an experienced board certified plastic surgeon or dermatologist who does these injections frequently is your best chance for the best possible result.
How Much Do Injections Cost?

Prices vary according to geographical location and the experience and skill of the doctor doing your injection.

Nationally cost is $15-$20 per unit injected and the average treatment uses 25-50 international units (IU’s). Thus a treatment can cost $350 to $1000 depending on the amount used and the experience, skill and reputation of your doctor.

Be suspicious of low priced injections. Unscrupulous providers can dilute the product and your result will be compromised. Obviously less experienced, less busy doctors may cut prices to stimulate demand.

Where Can I Learn More?

There is a great deal of information on the web. However, much of it is advertising and marketing that often makes outrageous claims.

Allergan, the company that makes this medicine, has a good website which provides objective information.

For more infromation on Botox and Botulinum Toxin A call 978-369-4499 or email us. Read our free newsletter to learn more about non-surgical face and body rejuvenation. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Concord, Massachusetts
Boston Massachusetts

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